How humanity fought infectious disease before vaccination

Siddartha Mukherjee, who won the Pulitzer Prize for the magisterial “The Emperor of All Maladies,” a history of cancer, wrote in The New Yorker last month about the history of our ability to control infectious disease. The answer for one plague came came from the East, from an era before doctors and medical science. It’s a remarkable story. Mukherjee, an oncologist, explains:

As early as 1100, medical healers in China had realized that those who survived smallpox did not catch the illness again (survivors of the disease were enlisted to take care of new victims), and inferred that the exposure of the body to an illness protected it from future instances of that illness. Chinese doctors would grind smallpox scabs into a powder and insufflate it into a child’s nostril with a long silver pipe.

the novel coronavirus (image from Science Alert)

Vaccination with live virus was a tightrope walk: if the amount of viral inoculum in the powder was too great, the child would succumb to a full-fledged version of the disease—a disaster that occurred perhaps one in a hundred times. If all went well, the child would have a mild experience of the disease, and be immunized for life. By the seventeen-hundreds, the practice had spread throughout the Arab world. In the seventeen-sixties, women in Sudan practiced tishteree el jidderee (“buying the pox”): one mother haggling with another over how many of a sick child’s ripe pustules she would buy for her own son or daughter. It was an exquisitely measured art: the most astute traditional healers recognized the lesions that were likely to yield just enough viral material, but not too much. […]

Lady Mary Wortley Montagu, the wife of the British Ambassador to Constantinople, had herself been stricken by the disease, in 1715, leaving her perfect skin pitted with scars. Later, in the Turkish countryside, she witnessed the practice of [inoculation against smallpox] and wrote to her friends in wonder, describing the work of one specialist: “The old woman comes with a nut-shell full of the matter of the best sort of small-pox, and asks what vein you please to have opened,” whereupon she “puts into the vein as much matter as can lie upon the head of her needle.” Patients retired to bed for a couple of days with a fever, and, Lady Montagu noted, emerged remarkably unscathed. “They have very rarely above twenty or thirty [pox] in their faces, which never mark; and in eight days’ time they are as well as before their illness.”

She reported that thousands safely underwent the operation every year, and that the disease had largely been contained in the region. “You may believe I am well satisfied of the safety of this experiment,” she added, “since I intend to try it on my dear little son.” Her son never got the pox.

In short, long before what we know today as ‘Western medicine,” clever humans discovered the power of inoculation, by which our immune system is given the tools to recognize and target a particular pathogen. This method, standardized and updated scientifically, is the means by which we humans eliminated smallpox from the earth. A great achievement that has saved countless lives. It’s the same basic method — without using risky live viruses — by which medicine today hopes to foil COVID-19.

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